Category Archives: Health Care

Boomerang: Opioid Overdoses Surge

by James A. Bacon

When governments shut down economic and social activity to quell the spread of the COVID-19 virus, Bacon’s Rebellion has frequently warned, they run the risk of engendering unintended consequences. We have predicted negative impacts from job loss and social isolation on mental health, substance abuse, domestic abuse, and suicide. Just because state government doesn’t report those numbers real-time, as it does with COVID-19 cases, doesn’t mean the impacts aren’t real.

Thanks to a study published in the Journal of the American Medical Association, we do have data on opioid overdoses at the Virginia Commonwealth University Medical Center. The surge is dramatic and impossible to ignore.

While overall emergency room visits declined 29% between March and June 2020 compared to the same period the year before, nonfatal opioid overdoses leaped 123%. Continue reading

Two of Five Virginians Say Nix to COVID-19 Vaccine

by James A. Bacon

Don’t count on a vaccine to end the COVID-19 epidemic — not in Virginia anyway. Four out of 10 Virginians say they are likely to not get a vaccine, even if approved by the Food and Drug Administration and made available for free. Only 58% say they are “somewhat” or “very” likely to do so, according to a poll released yesterday by the Virginia Commonwealth University school of government.

Last month State Health Commissioner Dr. Norman Oliver said that he planned to mandate a COVID-19 immunization once it was safely released to the public. Focused on “accessibility, affordability and fair distribution” of a vaccine, Governor Ralph Northam said he was not planning a mandate at that time. As it turns out, two thirds of those responding to the VCU poll said they oppose requiring everyone to get a COVID-19 vaccine. 

As I have blogged previously, there are legitimate questions to ask about the efficacy of any vaccine. No vaccine is 100% effective. Various experts have opined that a vaccine likely to meet FDA approval would immunize between 75% and 90% of people exposed to the coronavirus. People have to balance the potential protection against the risks of side effects such as fever, fatigue and headaches.

In the poll, 63% of Independents and 59% of Democrats said they were very or somewhat likely to get the vaccine, while only 49% of Republicans saying they were. It will be fascinating to see if those numbers flip as the vaccine issue becomes polarized along partisan lines, as appears to be happening. Continue reading

VCU Health to Launch Voter-Registration Drive on Hospital Premises

Image from a VotER voter registration kit.

by James A. Bacon

The Virginia Commonwealth University Health System has informed employees that it will participate in the VotER Initiative to encourage patients to register to vote and vote by mail.

“A large body of research tells us that sick Americans are less likely to vote,” commences the communication from Sheryl L. Garland, chief of health impact for the health system. “This is especially true of individuals who also have significant social needs, such as a lack of stable food and housing. All to often, these voices are not heard when decisions that affect their health are made.”

The email explicitly tied the initiative, which will start today, to VCU’s commitment to diversity and inclusion: “VCU Health’s Diversity, Equity, and Inclusion Statement states that ‘we will actively work to dismantle systemic racism and inequalities that may be entrenched in our health system.’ VCU Health’s participation in this initiative is a small but meaningful step toward fulfilling this commitment.”

According to the communique, VCU will place flyers in clinic waiting rooms and larger posters in high-traffic areas within the hospitals.  Continue reading

Is a COVID Surge Coming in October?

by Carol J. Bova

Statewide, the R0 (R-naught) value for COVID-19 moved up to 1.004 because of surges in the Near Southwest and Northwest for the week ending August 22, according to the Virginia Department of Health’s latest COVID-19 Model Weekly Update. If the RO is above 1, it indicates the potential for exponential increases in the spread of a disease.

The red areas on the map show surging hot spots in the New River and Richmond City Health Districts. Seven slow-growth areas are in deep yellow and declining numbers are the deeper blue. VDH offers no explanation for why the Eastern Region districts are all declining or for the plateau for the remaining districts.

The model projects about 78,000 new cases by Thanksgiving, with a peak of 8,300 cases during the week ending October 18th. The report says that seasonal changes like schools reopening, flu season and changing weather patterns could increase the weekly case numbers, too. Adding in a possible 10% to 20% increase in cases after Labor Day, the model forecast jumps to 11,000 to 14,000 for the week ending October 25th. Continue reading

Vitamin D and COVID-19

by Carol J. Bova

Researchers at the University of Chicago have found that Vitamin D deficiency is associated with a higher  likelihood of contracting the coronavirus. In combination with other Vitamin D research, the results may point the way to a quick and inexpensive way to reduce COVID-19 deaths among African-Americans and Hispanics.

David Meltzer, MD, Ph.D, lead author of the article published September 3rd in JAMA Network Open, discussed their findings on a University of Chicago Medicine website. “Vitamin D is important to the function of the immune system and vitamin D supplements have previously been shown to lower the risk of viral respiratory tract infections. Our statistical analysis suggests this may be true for the COVID-19 infection.”

Another study from Spain, published August 29, had test and control groups well-matched for age, sex, comorbidities and clinical indications of COVID-19 severity. In the control group, 50% were admitted to ICU and two died. In addition to the same drugs given to the control group, the test group was given calcifediol, a vitamin D analog, which increases vitamin D levels in the body. The test group had no deaths and only 2% had to be admitted to the ICU. Continue reading

It Matters Where You Seek COVID Data

VDH chart of COVID-19 deaths over time in Virginia’s Northern Region, as of 9/5. Click for larger view.  Having been hit the worst early, it is now doing better than ROVA.

By Steve Haner

Even when there is no intent to twist the data, it still matters where you look if you want to see Virginia’s status in dealing with Our Permanent Pandemic.

The chart on the daily death count, for example, looks dramatically different on the Virginia Department of Health’s website when compared to the Virginia Public Access Project daily updates. It is clear example of how the same data can seem vastly different based on presentation.

What apparently is going on is that as VDH issues daily updates, the compilers at the health department account for each death on the date of actual death, which means 20 new reports on one day might be spread out back a week or more. At VPAP, the daily count is the daily count.

So, you get this chart below from VDH, as of Saturday.  See the steady decline in deaths, and the huge difference from the early peak to the present day.

VDH chart of statewide deaths over time, as of 9/5. Click for larger view.

VPAP chart of Virginia deaths over time, as of 9/5. Click for larger view.

The VPAP bar chart and seven-day average show more peaks, and a would lead you to conclude Virginia is in more dire shape. It shows a seven-day average death rate of about 15, almost three times the VDH chart’s seven day average below of below six. Fifteen versus six is a huge deal. Continue reading

Hey, Commish, Not So Fast on the COVID Vaccine

GeraldFordgettingvaccine.jpeg

by Kerry Dougherty

Well, he did it again. Virginia’s Commissioner of Misinformation, er Health, shot off his mouth and alarmed the public, and then state government factotums had to do damage control.

On Friday,  WRIC ABC News reported that Virginia State Health Commissioner Dr. Norman Oliver “plans to mandate coronavirus vaccinations for Virginians once one is made available to the public.”

Virginia state law gives the Commissioner of Health the authority to mandate immediate immunizations during a public health crisis if a vaccine is available. Health officials say an immunization could be released as early as 2021.

Dr. Oliver says that, as long as he is still the Health Commissioner, he intends to mandate the coronavirus vaccine.

“It is killing people now, we don’t have a treatment for it and if we develop a vaccine that can prevent it from spreading in the community we will save hundreds and hundreds of lives,” Oliver said.

Under state law, only people with a medical exemption could refuse the mandate.

With that, Oliver became the first state official in the US to threaten compulsory COVID vaccinations.

Bringing Analytical Clarity to the COVID Shutdown Debate

by James A. Bacon

While we’re on the subject of lazy, undisciplined thinking about COVID-19 vaccine mandates (see previous post), let’s address the topic of lazy, undisciplined thinking about economic shutdowns. The Wall Street Journal‘s Greg Ip brings some refreshing analytical clarity to the debate.

Ip addresses public policy responses to the COVID contagion around the world. Options can be viewed on a spectrum from a heavy authoritarian hand (China quarantining entire city populations) to an almost libertarian approach (Sweden restricting only large gatherings). The response of most countries, including the United States, has been between the two extremes.

Unfortunately, the U.S. response has been confused, vacillating and sub-optimal. Polarized between “protecting lives” and “protecting the economy,” Americans don’t really know what they’re trying to accomplish. Writes Ip: Continue reading

It’s Way too Early to Discuss a Vaccine Mandate

by James A. Bacon

Four days ago State Health Commissioner Dr. Norman Oliver said he planned to mandate a COVID-19 immunization once it’s safely released to the public. Yesterday Governor Ralph Northam said he’s not planning a mandate, despite what his top health official said.

When asked why the the Governor wasn’t embracing the stance of his top health official, Northam spokesperson Alena Yarmosky said in a statement, “We are focused on accessibility, affordability, and fair distribution of a vaccine—not on a mandate.”

“When a vaccine becomes available, we’re confident that Virginians will seek it out. That’s why we don’t have plans for a mandate,” Yarmosky continued in a separate email, reports WAVY TV.

I’m no expert on the subject of vaccines, to be sure, but it strikes me as way too premature to begin discussing a mandate. Many potential vaccine candidates are being tested, we don’t which one (or ones) will be approved, and we know nothing about the efficacy, side effects and trade-offs of each. Continue reading

Nursing Home PPE Shortages and Deaths Still Rising

Deaths in cases originating at Virginia long-term care facilities.

by Carol J. Bova

After a review of over 15,000 nursing home reports submitted to the Centers for Medicare and Medicaid (CMS), Brian E. McGarry, David C. Grabowski, and Michael L. Barnett published a paper in Health Affairs on August 20th. In “Severe Staffing and Personal Protective Equipment Shortages Faced by Nursing Homes During the COVID-19 Pandemic,” they concluded, “Despite intense policy attention and mounting mortality, the shortages have not meaningfully improved from May to July of 2020.”

While six fewer Virginia nursing homes reported nursing staff shortages as of August 9,  there were more reports of all other staff shortages and supplies of Personal Protective Equipment (PPE) between the weeks ending June 7 and August 9 according to the CMS COVID-19 Nursing Home Dataset. Meanwhile, COVID-19 cases and deaths continue to rise. Continue reading

The Tell Tale Heart: Racism in Richmond Medicine

By Peter Galuszka

On Saturday, May 25, 1968, the Medical College of Virginia, now part of Virginia Commonwealth University, made medical history.  A surgeon recruited from Stanford University a couple of years before successfully transplanted the heart from one middle-aged man to another.

MCV officials in Richmond officials were ecstatic. Organ transplants were a hot, fairly new surgical procedure. Once stuck in the junior varsity leagues of medical training and research, MCV was basking in glory from media coverage.

There was one peculiarity that no one seemed to notice. The name of the heart donor was missing. As it turned out, the donor was Bruce Tucker, a Richmond Tucker happened to be African-American.

Tucker had suffered a serious brain injury from a fall the day before. He was taken to MCV. Hospital officials made a perfunctory search for his relatives. Tucker’s brother was desperately looking for him and his business card was in Bruce’s pocket. No one found it.

So, after Bruce was pronounced dead, his heart was removed and placed in the chest of Richard G. Klett, a white business executive from Orange. This shocking story is well documented in a highly readable book by Richmond author and journalist Chip Jones that has been just published by an imprint of Simon & Schuster. Tucker’s brother finally located hospital officials who started talking about an autopsy and that he needed to find a funeral director. Continue reading

Shhh. COVID Deaths Drop. Keep It Quiet.

Virginia Department of Health. Click for larger view. Go to the website for the interactive version.

Isn’t this always the way? Just as the Virginia General Assembly arrives in Richmond to save us from COVID-19, Virginia’s number are getting way better.The 7-day average for deaths in the Northern Virginia region tracked by the Virginia Department of Health is zero. Zero. It has recorded zero deaths in August so far.

The statewide 7-day average, which tracks about a week back, has dropped to 5 deaths per day, the lowest average since the pandemic’s initial assault. That’s the chart above. Eastern Virginia’s 7-day death average is now below two per day, and here in the Central (read Capitol) region, is it about one death every other day. That region has had only six deaths recorded so far in August.  Continue reading

Governor Northam, Crack Down on Nursing Homes, Not Restaurants

By Carol J. Bova

Last week Julie Henderson, director of the Virginia Department of Health (VDH) Office of Environmental Health Services, said her agency was going to request $6 million for 92 positions to educate the public and businesses about executive orders and how to enforce them.

If there is $6 million available for enforcement and education personnel, send them out to the nursing homes, correctional facilities and other congregate settings. Restaurants are not causing the deaths and suffering occurring from those outbreaks.

Of 956 virus deaths reported since June 1, 498 or 52% were from long term care facilities. Since the outbreak tracking began, long-term care facilities were responsible 1,294 of 1,370 outbreak deaths – that’s 94.5% of all outbreak deaths.

Let citizens make their own choices about going to restaurants. Post a warning if a restaurant isn’t meeting your standards, but shutting them down based on a complaint system isn’t going to save lives in the same way enforcing basic hygiene and infection controls in nursing homes will. Put the money where it’s going to make a difference. Continue reading

COVID Workers Comp On House Democrat Bill List

By Steve Haner

The coming Special Session of the General Assembly will be narrowly focused but filled with controversy, based on the legislative wish list just released by House of Delegates Democrats. Only two bills listed fall outside of the major categories of “COVID-19 Relief” or “Criminal Justice and Police Reform.”

Under the heading “COVID Relief,” the Democrats wish to reopen their drive for employee paid leave and. as predicted. want to designate COVID-19 as a workplace disease.

The Senate Democrats have their own list, released in June and reiterated in a more recent news release. The release claims that one of the bills is ready for public viewing, but provides no link and the bill mentioned is not yet available through Legislative Information Services. Neither caucus has yet revealed any thoughts on how to amend the state budget, a task where Governor Ralph Northam naturally takes the lead.

Here is the list from the House Democratic Caucus, with some thoughts following:

COVID-19 Relief:

  • Requiring businesses to grant paid sick leave for Virginia workers.
  • Prohibiting garnishments of stimulus relief checks. (Office of Attorney General bill)
  • Establishing a presumption of workers’ compensation for first responders, teachers, and other high-risk essential workers.
  • Providing immunity from civil claims related to COVID-19 for complying with health guidance.
  • Combating price gouging for Personal Protective Equipment. (Office of Attorney General bill)
  • Protecting Virginians from eviction during a public health emergency.
  • Creating a Commonwealth Marketplace for PPE Acquisition.
  • Mandating transparency requirements for congregate-care facilities during a public health emergency.

Continue reading

Covid-19 Testing for Nursing Homes – the Strange Case of Heritage Hall

By Carol J. Bova and James C. Sherlock

The Department of Health and Human Services announced that it would begin to provide 2000 nursing homes with a point of care (POC) rapid-response testing assessment instrument and an initial supply of COVID-19 test assays starting July 20th.

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said, “It gives nursing homes the ability to swiftly identify residents that need to be isolated and mitigate the spread of the virus.”

Eventually, 15,000 analyzer instruments and an initial supply of SARS test assays for those instruments will be distributed nationally directly to nursing homes.

Devices have been allocated to the first 23 of Virginia’s nearly 300 nursing homes.

Heritage Hall. Tommy East is the President and CEO of American Healthcare, LLC, which controls Heritage Hall nursing homes. Mr. East is also listed as a director and officer for each Heritage Hall facility. He is the sole nursing home industry representative on the Virginia Board of Health.

Seven of 18 Heritage Hall nursing homes made it to the head of the line for the first 23 analyzer systems and test assays distributed in Virginia by the CMS program. Heritage Hall is the largest Commonwealth-based operator of nursing homes.

Continue reading